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Abdominal Wall Pain or Irritable Bowel Syndrome

Validation of a Pediatric Questionnaire

Siawash, Murid*; van Assen, Tijmen; Ten, Walther Tjon a; Jansen, Loes*; van Heurn, Ernst§; Roumen, Rudi*; Scheltinga, Marc*

Journal of Pediatric Gastroenterology and Nutrition: May 2, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002366
Original Article: Gastroenterology: PDF Only

Objectives: A questionnaire study demonstrated that some adult patients who were diagnosed with Irritable Bowel Syndrome (IBS) were in fact having an abdominal wall pain syndrome such as anterior cutaneous nerve entrapment syndrome (ACNES). The aim of the present study was to investigate whether a pediatric version of this questionnaire was useful in diagnosing abdominal wall pain syndromes in children with chronic abdominal pain (CAP).

Methods: An 18-item questionnaire was tested in three groups of children with CAP: I. children who underwent surgery for ACNES (n = 42); II. Children who were found to have ACNES after an outpatient analysis (n = 57), and III. Children diagnosed with IBS (n = 53). Qualities including internal consistency (Cronbach's α), cut-off points and a ROC-curve were calculated using standard statistical analysis.

Results: Questionnaire response rates in the three populations of CAP children ranged from 69–92%. When comparing ACNES and IBS groups, 17 of 18 questions were discriminative (p < 0.01, Cronbach's α 0.74). Total questionnaire scores ranged from 0 (IBS likely) to 17 points (ACNES likely). A median 13 point score (range 8–17) was found in both ACNES groups. In contrast, a median 8 point score was calculated in children with IBS (range 3–13, p < 0.01). Using an 11 point cut-off score, a child with CAP was diagnosed with ACNES with 86% sensitivity and 89% specificity. A ROC curve with an AUC of 0.94 was obtained.

Conclusion: A 17-item questionnaire showed good diagnostic test properties and may aid in distinguishing ACNES from IBS in pediatric populations with chronic abdominal pain.

*SolviMáx, Center of Excellence for Abdominal Wall and Groin Pain, Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands

Department of Rehabilitation, Physiotherapy Sciences & Sport, University Medical Center Utrecht, The Netherlands

Department of Pediatrics, Máxima Medical Center, Veldhoven, The Netherlands

§Department of Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands.

Address correspondence and reprint requests to Murid Siawash, Department of Surgery, Máxima Medical Center, PO Box 7777, Veldhoven, The Netherlands (e-mail:

Received 18 December, 2018

Accepted 20 February, 2019

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Disclosures: The authors have no financial relationships relevant to this article to disclose. The authors have no conflicts of interest to disclose.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,